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Ram E, Sternik L, Moshkovitz Y, Iakobishvili Z, Zuroff E, Peled Y, Herscovici R, Raanani E. Coronary Artery Bypass Grafting Following Acute Coronary Syndrome: Impact of Gender. Semin Thorac Cardiovasc Surg 2021; 34:920-929. [PMID: 34289411 DOI: 10.1053/j.semtcvs.2021.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
The impact of gender on clinical outcomes after coronary artery bypass grafting (CABG) has generated conflicting results. We investigated the impact of gender, on 30 day mortality, complications and late survival in patients with acute coronary syndrome (ACS) undergoing CABG. The study included 1308 patients enrolled from the biennial Acute Coronary Syndrome Israeli Survey between 2000 and 2016, who were hospitalized for ACS and underwent CABG. Of them, 1045 (80%) were men and 263 (20%) women. While women were older and had more hypertension and hyperlipidemia, they demonstrated less diabetes mellitus, previous ischemic heart disease, smoking, and fewer implicated coronary arteries. Women presented with more atypical symptoms as compared to men (26.3% vs 19.4%, p = 0.017). Overall multivariable-adjusted 30 day mortality was higher in women than in men (OR 2.47 95% CI 1.19-5.1, p = 0.015). Among patients with ST-elevation myocardial infarction (STEMI) or non-STEMI, women had a higher 10 year mortality rate than men (42.5% vs 19.2%, log-rank p < 0.001 and 31.5% vs 20.7%, log-rank, p = 0.012). However, in patients with unstable angina pectoris on admission, these differences were not seen (16.9% vs 13.4%, log-rank p = 0.540). Multivariable analysis demonstrated that female gender was a significant predictor for 10 year mortality (HR 1.39, 95% CI 1.02-1.9, p = 0.038). In a real-life setting, women constitute an independent predictor for short- and long-term mortality following ACS treated by CABG surgery. The reasons for a higher mortality in women should be further investigated as well as specific and/or more intensive therapies after CABG in this high-risk group of patients.
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Affiliation(s)
- Eilon Ram
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
| | - Leonid Sternik
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Yaron Moshkovitz
- Department of Cardiothoracic Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Zaza Iakobishvili
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel; Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elchanan Zuroff
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Yael Peled
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Romana Herscovici
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery and Cardiology, Tel Aviv University, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
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Cui Z, Li N, Gao C, Fan Y, Zhuang X, Liu J, Zhang J, Tan Q. Precision implementation of early ambulation in elderly patients undergoing off-pump coronary artery bypass graft surgery: a randomized-controlled clinical trial. BMC Geriatr 2020; 20:404. [PMID: 33054724 PMCID: PMC7560239 DOI: 10.1186/s12877-020-01823-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/07/2020] [Indexed: 01/17/2023] Open
Abstract
Background Although early ambulation (EA) is associated with improved outcomes in post-operative patients, implementation of EA in elderly patients is still a challenge. In this study, we aimed to design and assess a precision early ambulation program for cardiac rehabilitation. Methods We conducted a single-center, randomized and controlled clinical trial in elderly patients aged over 60 years after off-pump coronary artery bypass graft (OPCABG) surgery. Patients were randomly assigned to a precision early ambulation (PEA) group or a routine ambulation (Control) group. Age-predicted maximal heart rate (APMHR) and maximal oxygen uptake (VO2max) were used as a reference to formulate and monitor the PEA regimen. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-points included 90-day mortality, incidence of early discharge, laboratory tests, length of ICU stay, the incidence of multiple organ complications and post-traumatic stress disorder (PTSD). Ambulation outcomes were also recorded. Results In total, 178 patients were enrolled (n = 89 per group). In the intent-to-treat analysis, PLOS in the PEA group was shorter than that in the Control group (9.04 ± 3.08 versus 10.09 ± 3.32 days, respectively. Mean difference 1.045 days; 95% confidence interval [CI] 0.098–1.992; P = 0.031 in the unadjusted model; mean difference 0.957 days; CI 0.007–1.907; P = 0.048 in adjusted model). The incidence of early discharge differed significantly between the PEA and control groups (41[46.1%] versus 24[27.0%] patients, respectively. Odds ratio [OR] 0.432; CI 0.231–0.809; P = 0.009 in unadjusted model; OR 0.466; CI 0.244–0.889, P = 0.02 in adjusted model). The time of first bowel movement, partial pressure O2 and post-traumatic stress disorder score in the PEA group were better than those in the Control group. Participants walked much longer distances on day 3 in the PEA group than those in the Control group (76.12 ± 29.02 versus 56.80 ± 24.40 m, respectively, P < 0.001). Conclusion APMHR and VO2max are valuable for implementation of PEA according to an established security threshold. PEA after OPCAPG surgery is safe and reliable for elderly patients, not only reducing the hospital stay, but also improving their physiological and psychological symptoms. Trial registration This study is a component of a protocol retrospectively registered: Application of ERAS in cardiovascular surgery. Trial registration number: ChiCTR1800018167. Date of registration: 3rd September, 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx
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Affiliation(s)
- Zhaomei Cui
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Na Li
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Chaonan Gao
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Yiou Fan
- Department of Toxicological and Functional Test, Centers for Disease Control and Prevention of Shandong, Jinan, 250014, China
| | - Xin Zhuang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Jing Liu
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Jie Zhang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Qi Tan
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China. .,Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China.
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Lemaire A, Soto C, Salgueiro L, Ikegami H, Russo MJ, Lee LY. The impact of age on outcomes of coronary artery bypass grafting. J Cardiothorac Surg 2020; 15:158. [PMID: 32611349 PMCID: PMC7328264 DOI: 10.1186/s13019-020-01201-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE As the population ages, increasing number of older patients are undergoing adult cardiac surgery. The purpose of the study is to assess the impact of age on postoperative outcomes in patients that undergo coronary artery bypass grafting (CABG). METHODS Patients that are ≥70 years old who underwent CABG were selected from the Nationwide/National Inpatient Sample from 2010 to 2015 using ICD-9-CM diagnosis and procedure codes. The patients who were 70-79 years old were compared to patients aged 80-89 years old to determine if the age difference of the patients had an impact on surgical outcomes. In addition, a secondary endpoint is to compare surgical outcomes between the 2 genders of the patients 80-89 years old. The rates of postoperative complications, and mortality were compared. RESULTS A total of 67,568 patients were identified who were ≥ 70 years old and underwent CABG. Compared to the Septuagenarians, the Octogenarians were more likely to develop cardiac complications (OR [odds ratio] =1.20, 95% CI [confidence interval] 1.12-1.23. They were also more likely to develop renal complications (P < 0001), and respiratory complications (P < 0001). The Octogenarians were also more likely to bleed postoperatively (P < 0.0001) and have a higher mortality (P < 0001). Furthermore, the female Octogenarians had a higher mortality (OR 1.25 95% CI 1.07-1.46) compared to males in the same age group. CONCLUSIONS The patients who were ≥ 80-89 years old had worse postoperative outcomes. The Octogenarians who were females had a higher mortality compared to their male counterparts.
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Affiliation(s)
- Anthony Lemaire
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA.
| | - Cassandra Soto
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
| | - Lauren Salgueiro
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
| | - Hirohisa Ikegami
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
| | - Mark J Russo
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
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Preventza O, Price MD, Amarasekara HS, Orozco-Sevilla V, Chatterjee S, Zhang Q, de la Cruz KI, Coselli JS. In the endovascular era, is elective open aortic arch surgery in elderly patients still justified? J Thorac Cardiovasc Surg 2019; 158:973-979. [DOI: 10.1016/j.jtcvs.2018.11.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022]
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Wang W, Wang Y, Piao H, Li B, Wang T, Li D, Zhu Z, Xu R, Liu K. Early and Medium Outcomes of On-Pump Beating-Heart versus Off-Pump CABG in Patients with Moderate Left Ventricular Dysfunction. Braz J Cardiovasc Surg 2019; 34:62-69. [PMID: 30810676 PMCID: PMC6385843 DOI: 10.21470/1678-9741-2018-0207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/24/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aims to compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. METHODS This is a retrospective study of ischemic heart disease patients with LVEF between 30% and 40% who underwent surgical revascularization from January 2013 to December 2017. Patients were divided into OPBH group (n=44) and OPCABG group (n=68), according to the surgical method. Clinical material with early and medium outcomes were investigated and compared between these groups. RESULTS The two groups had similar baseline. Two OPBH patients and 3 OPCABG patients died in the hospital, which had no statistical significance (P>0.05). OPBH patients received a greater number of grafts (3.74±0.84) and presented more improved LVEF (45.92±7.11%) than OPCABG patients (3.36±0.80) and (42.81±9.29%), respectively, which had statistical significance (P<0.05). An increased amount of drainage during the first 12 hours was found in the OPBH group (P<0.05). Reoperation for bleeding, duration of mechanic ventilation, and other early outcomes had no statistical significance between the two groups. During the medium-time follow-up, OPBH patients showed significantly lower major adverse cardiovascular events (MACE)-free survival time (P=0.049) than OPCABG patients. CONCLUSION The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better mid-term MACE-free survival compared with OPCABG.
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Affiliation(s)
- Weitie Wang
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
| | - Yong Wang
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
| | - Hulin Piao
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
| | - Bo Li
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
| | - Tiance Wang
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
| | - Dan Li
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
| | - Zhicheng Zhu
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
| | - Rihao Xu
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
| | - Kexiang Liu
- Department of Cardiovascular Surgery, 2nd Hospital of Bethune, Jilin University, Changchun, Jilin, China
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The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9829487. [PMID: 29423414 PMCID: PMC5750486 DOI: 10.1155/2017/9829487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/26/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022]
Abstract
The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p < 0.0001), cardiac-related mortality (p < 0.0001), incidence of acute myocardial infarction (p = 0.01), and stroke rates (p < 0.0001). Patients < 60 years required repeated revascularization more frequently than older patients (p = 0.05). Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.
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Nicolini F, Vezzani A, Romano G, Carino D, Ricci M, Chicco MVD, Gherli T. Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly. Int Heart J 2017; 58:647-653. [PMID: 28966319 DOI: 10.1536/ihj.16-468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues.The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients.
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Affiliation(s)
- Francesco Nicolini
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | | | - Giorgio Romano
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | - Davide Carino
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | - Matteo Ricci
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
| | | | - Tiziano Gherli
- Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma
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Xia L, Ji Q, Song K, Shen J, Shi Y, Ma R, Ding W, Wang C. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. J Cardiothorac Surg 2017; 12:11. [PMID: 28231841 PMCID: PMC5322671 DOI: 10.1186/s13019-017-0572-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/25/2017] [Indexed: 12/05/2022] Open
Abstract
Background Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction. Methods A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared. Results Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less. Conclusions The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.
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Affiliation(s)
- LiMin Xia
- Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China
| | - Qiang Ji
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - Kai Song
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - JinQiang Shen
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - YunQing Shi
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - RunHua Ma
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - WenJun Ding
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China
| | - ChunSheng Wang
- Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China.
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Nicolini F, Vezzani A, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, De Palma R, Gherli T. Gender differences in outcomes following isolated coronary artery bypass grafting: long-term results. J Cardiothorac Surg 2016; 11:144. [PMID: 27716382 PMCID: PMC5045636 DOI: 10.1186/s13019-016-0538-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/27/2016] [Indexed: 12/05/2022] Open
Abstract
Background The main purpose of this study was to evaluate the impact of gender on outcomes after isolated coronary artery bypass grafting, in terms of 5-year rates of overall death, cardiac-related death, myocardial infarction, re-hospitalization, repeat percutaneous or surgical revascularization, stroke, new pacemaker implantation, postoperative renal failure, heart failure and need for long-term care. Methods Two propensity-score matched cohorts, each of 1331 patients, undergoing isolated surgical coronary revascularization at the regional public and private centers of Emilia-Romagna region (Italy) from January 1st 2003 to December 31th 2013, were used to compare long-term outcomes of male (5976 patients) versus female gender (1332 patients). Results In the matched cohort, males received significantly more bypass grafts (3.0 ± 1.0 vs 2.8 ± 1.0, p = 0.001). Left internal mammary artery use and total arterial revascularization were similarly performed in both matched subgroups. Both groups reported similar cumulative rate of all-cause, cardiac-related mortality and stroke at five years. Females experienced significantly higher rate of myocardial infarction, and not significantly higher occurrence of heart failure, and need for long-term care. Males experienced significantly higher rate of cumulative re-hospitalization and higher need for pacemaker implantation. Female gender was not an independent predictor of death at long-term follow-up. Conclusions Women are more likely to be readmitted with myocardial infarction and congestive heart failure after CABG but experience survival similar to that observed in men. Female gender was not an independent risk factor for mortality. Prevention of new occurrence of postoperative myocardial infarction and enhancement of complete coronary revascularization should be future endpoints.
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Affiliation(s)
- Francesco Nicolini
- Clinical and Experimental Medicine Department, Cardiac Surgery Unit, University of Parma, Parma, Italy. .,Heart Surgery Unit - University of Parma, Via A. Gramsci 14, 43126, Parma, Italy.
| | - Antonella Vezzani
- Surgery Department, Cardiac Surgery Unit, Parma Hospital, Parma, Italy
| | | | | | - Davide Pacini
- Cardio-Thoracic-Vascular Department, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Davide Gabbieri
- Department of Clinical Cardiology and Thoraco Vascular Surgery, Hesperia Hospital, Bologna, Italy
| | - Claudio Zussa
- Department of Cardiology and Cardiac Surgery, Villa Maria Cecilia Hospital, Bologna, Ravenna, Italy
| | | | - Tiziano Gherli
- Clinical and Experimental Medicine Department, Cardiac Surgery Unit, University of Parma, Parma, Italy
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Gatti G, Dell’Angela L, Benussi B, Dreas L, Forti G, Gabrielli M, Rauber E, Luzzati R, Sinagra G, Pappalardo A. Bilateral internal thoracic artery grafting in octogenarians: where are the benefits? Heart Vessels 2015; 31:702-12. [DOI: 10.1007/s00380-015-0675-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
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Coronary Artery Surgery Versus Percutaneous Coronary Intervention in Octogenarians: Long-Term Results. Ann Thorac Surg 2015; 99:567-74. [DOI: 10.1016/j.athoracsur.2014.09.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 11/20/2022]
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The evolution of cardiovascular surgery in elderly patient: a review of current options and outcomes. BIOMED RESEARCH INTERNATIONAL 2014; 2014:736298. [PMID: 24812629 PMCID: PMC4000933 DOI: 10.1155/2014/736298] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/25/2014] [Indexed: 01/22/2023]
Abstract
Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care have led to the possibility that an increasing number of elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery, and major surgery of the aorta are performed in elderly patients. The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease, and poor clinical state are associated with a worse outcome in elderly patients. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia, and adequate myocardial protection are basic requirements for the success of cardiac surgery in elderly patients. The care of elderly cardiac surgical patients can be improved only through the strict collaboration of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a tailored treatment for each individual patient.
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Comparison of contemporary risk scores for predicting outcomes after surgery for active infective endocarditis. Heart Vessels 2014; 30:227-34. [DOI: 10.1007/s00380-014-0472-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
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Ji Q, Mei Y, Wang X, Ding W. On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in High-Risk Patients. Int Heart J 2014; 55:484-8. [DOI: 10.1536/ihj.14-088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Qiang Ji
- Departments of Thoracic Cardiovascular Surgery, Tongji Hospital of Tongji University
| | - YunQing Mei
- Departments of Thoracic Cardiovascular Surgery, Tongji Hospital of Tongji University
| | - Xisheng Wang
- Departments of Thoracic Cardiovascular Surgery, Tongji Hospital of Tongji University
| | - Wenjun Ding
- Department of Cardiovascular Surgery, Zhongshan Hospital of Fudan University
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15
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Emrecan B, Onem G, Ozdemir AC, Kılıç ID, Alihanoğlu Yİ. A good surgical option for ischemic mitral regurgitation in co-morbid patients: semicircular reduction annuloplasty. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:141-5. [PMID: 23888173 PMCID: PMC3708053 DOI: 10.3969/j.issn.1671-5411.2013.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/23/2012] [Accepted: 12/03/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ring annuloplasty is the standard treatment of ischemic mitral regurgitation (MR), however, it has been associated with some drawbacks. It abolishes normal annular dynamics and freezes the posterior leaflet. In the present study, we evaluated Paneth suture annuloplasty in chronic ischemic MR and both early and mid-term outcomes of the technique on a selected population. METHODS The study period was from June 2010 to June 2012. We operated on 21 patients who had the diagnosis of coronary artery disease and MR of grade 3 or 4. The patients had both a coronary artery bypass operation and the mitral semicircular reduction annuloplasty described by Paneth-Burr. The data on the patients were retrospectively collected. Patients were contacted by outpatient clinic controls for mid-term results. RESULTS The male/female ratio was 10/11. The mean age of the patients was 71.0 ± 6.4 years. Preoperative and postoperative left ventricular ejection fraction was statistically similar (P = 0.973). Early postoperative MR grade (mean, 0.57 ± 0.51) was statistically lower than the preoperative MR grades (mean, 3.38 ± 0.50) (P < 0.001). There was no revision for excess bleeding. Two patients had prolonged hospitalization, one for sternal infection and the other for severe chronic obstructive pulmonary disease. No hospital or late postoperative deaths occurred. The mean late postoperative MR grade was 0.66 ± 0.97 degrees. One patient had progression of MR in the later follow-up, which was treated by mitral valve replacement. CONCLUSION Semicircular reduction annuloplasty is an effective, inexpensive and easy surgical annuloplasty technique with low mortality and morbidity in severe symptomatic ischemic MR.
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Affiliation(s)
- Bilgin Emrecan
- Department of Cardiac and Vascular Surgery, Pamukkale University, Kınıklı, Denizli 20070, Turkey
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A unique stenosis in saphenous vein graft visualized by optical coherence tomography. Heart Vessels 2013; 29:278-81. [PMID: 23712599 PMCID: PMC3948513 DOI: 10.1007/s00380-013-0362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 04/26/2013] [Indexed: 11/14/2022]
Abstract
We present a case of a unique stenosis in a 12-year-old saphenous vein graft (SVG), to the right coronary artery, which was visualized by optical coherence tomography (OCT), before percutaneous coronary intervention. The patient was an 80-year-old man in whom the stenosis was documented by area-detector coronary computed tomography. OCT imaging demonstrated that the culprit lesion was a venous valve containing a thrombus before preintervention imaging. Coronary stenting was performed with a distal protection device, and pathologic examination of the aspirate verified the OCT findings. Coronary angiography 12 years previously, just after coronary artery bypass surgery (CABG), had shown a completely normal SVG without any suspicion of a venous valve. These OCT images suggested the possibility that the culprit lesion was an “upside down” venous valve that was not visualized by angiography just after surgery, but could be a cause of late SVG stenosis following CABG. OCT imaging is very useful for clarifying the etiology of the stenosis in cases of ambiguous angiographic lesions.
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Takahara M, Kaneto H, Katakami N, Iida O, Matsuoka TA, Shimomura I. Effect of sarpogrelate treatment on the prognosis after endovascular therapy for critical limb ischemia. Heart Vessels 2013; 29:563-7. [PMID: 23494607 PMCID: PMC4085500 DOI: 10.1007/s00380-013-0334-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 02/22/2013] [Indexed: 11/25/2022]
Abstract
5-Hydroxytryptamine type 2 antagonists are used to treat symptomatic peripheral arterial disease. However, it remains unknown as to whether the administration of sarpogrelate, a 5-hydroxytryptamine type 2 antagonist, improves the prognosis after endovascular therapy for critical limb ischemia (CLI). We performed a retrospective analysis using a database of 386 Japanese patients undergoing endovascular therapy for CLI. Sixty-seven patients were treated with sarpogrelate, and we compared their prognosis with that of an equal number of background-matched controls extracted from the population. The primary end point was the first event of either major amputation or death from any cause, and amputation-free survival was evaluated. The follow-up period was 21 ± 18 months (mean ± standard deviation), and 58 end points were observed. Patients treated with sarpogrelate had a significantly higher amputation-free survival rate than their matched controls (P = 0.036). The hazard ratio for the end point and its 95 % confidence interval was 0.57 (0.34–0.97). These results suggest that sarpogrelate treatment is associated with a favorable prognostic outcome in CLI patients undergoing endovascular therapy. Future prospective studies are required to investigate whether sarpogrelate treatment would improve the prognosis of CLI patients.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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